Rearward movement reversing device

Abstract

To provide a rearward moving inversion apparatus.SOLUTION: A rearward moving inversion apparatus includes a stone crusher, a collection passage, and an energy orientation device. The stone crusher is constituted so as to transmit energy to a tissue located in a tissue forming region. The collection passage can be arranged in a body lumen, or in the vicinity of the body lumen. The energy orientation device can be arranged in the stone crusher, or in the vicinity of the collection passage. The energy orientation device is constituted so as to make the tissue progress toward the collection passage.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] Priority claims This application claims the benefit of priority under 35 U.S.C. §119(e) of U.S. Patent Application No. 62 / 964,709, entitled "REVERSE RETROPULSION LITHOTRIPSY DEVICE," filed January 23, 2020, to Jan Pyro (Attorney Docket No. 5409.023PRV), the contents of which are incorporated herein by reference in their entirety. [Background technology]

[0002] Tissues can form within organs of the human body, such as within the kidney. In some cases, the tissue (e.g., stones) cannot pass through the organ naturally, requiring a surgical procedure to remove the tissue. Often, the tissue must be broken down into small pieces for removal from a body lumen, such as the kidney or urinary tract. Lithotripsy devices can be used to break up and remove the tissue. Common modalities of lithotripsy include laser lithotripsy, ultrasonic lithotripsy, and mechanical lithotripsy. In each of these modalities, energy can be delivered to the tissue from a lithotripsy device to break the tissue into small pieces for removal. Summary of the Invention [Means for solving the problem]

[0003] The retrograde movement reversal device comprises a lithotriptor configured to deliver energy to tissue located in a tissue formation region, a retrieval channel positionable in or near a body lumen, and an energy director positionable near the lithotriptor and the retrieval channel, the energy director configured to advance the tissue toward the retrieval channel. [Brief explanation of the drawings]

[0004] The drawings are not necessarily drawn to scale, and like reference numbers in different figures may represent like components. Like numbers with different suffixes may represent different instances of like components. The drawings illustrate generally, by way of example, and not by way of limitation, various embodiments discussed in the present document.

[0005] [Figure 1] 1A-1D are perspective and cross-sectional views of a lithotriptor according to at least one example of the present disclosure. [Figure 2] 1A and 1B are perspective and cross-sectional views of a portion of a lithotriptor according to at least one example of the present disclosure. [Figure 3A] 1 is a perspective view of a lithotriptor in a first state, according to at least one example of the present disclosure; FIG. [Figure 3B] FIG. 10 is a perspective view of a lithotriptor in a second state, according to at least one example of the present disclosure. [Figure 4A] FIG. 1 is a perspective view of a portion of a lithotriptor according to at least one example of the present disclosure. [Figure 4B] FIG. 1 is a perspective view of a portion of a lithotriptor according to at least one example of the present disclosure. [Figure 4C] FIG. 1 is a perspective view of a portion of a lithotriptor according to at least one example of the present disclosure. [Figure 5A] 5A is a cross-sectional view of a portion of a lithotriptor in a first condition taken along index line 5A-5A of FIG. 5B, in accordance with at least one example of the present disclosure. [Figure 5B] 5B is a cross-sectional view of a portion of a lithotriptor in a first condition, taken along index line 5B-5B of FIG. 5A, in accordance with at least one example of the present disclosure. [Figure 5C] 5C is a cross-sectional view of a portion of a lithotriptor in a second condition, taken along index line 5C-5C of FIG. 5D, in accordance with at least one example of the present disclosure. [Figure 5D] 5D is a cross-sectional view of a portion of a lithotriptor in a second condition taken along index line 5D-5D of FIG. 5C, in accordance with at least one example of the present disclosure. [Figure 5E] 10 is a cross-sectional view of a portion of a lithotriptor in a third condition, in accordance with at least one example of the present disclosure. [Figure 6]1 is a cross-sectional view of a portion of a lithotriptor according to at least one example of the present disclosure. [Figure 7] 1A and 1B are perspective and partial cross-sectional views of a portion of a lithotriptor according to at least one example of the present disclosure; [Figure 8] 1A and 1B are perspective and partial cross-sectional views of a portion of a lithotriptor according to at least one example of the present disclosure; [Figure 9A] 9A is a cross-sectional view of a portion of a lithotriptor taken along index line 9A-9A of FIG. 9B, in accordance with at least one example of the present disclosure. [Figure 9B] FIG. 9B is a cross-sectional view of a portion of a lithotriptor taken along index line 9B-9B of FIG. 9A, in accordance with at least one example of the present disclosure. [Figure 10] 1 is a cross-sectional view of a portion of a lithotriptor according to at least one example of the present disclosure. [Figure 11] 1 is a schematic diagram of a lithotripsy system according to at least one example of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0006] In each form of lithotripsy, energy is delivered to tissue from a lithotriptor to break the tissue into small fragments that can then be removed from the patient. However, the act of applying energy from the lithotriptor to the tissue can cause tissue retromotion, or movement of the tissue away from the lithotriptor. Retromotion of tissue during lithotripsy can complicate further tissue destruction and can complicate removal of the tissue and its fragments.

[0007] The present disclosure provides a solution to the problem of back migration by using back migration reversal. That is, tissue fragments can be directed towards the lithotriptor and, using an energy reversal device, directed towards the suction device or suction line. This can help reduce back migration of tissue and therefore help save time during the lithotripsy procedure.

[0008] In some examples, back migration reversal can be achieved by redirecting the energy delivered by the laser behind the tissue (or distal to the instrument) to direct the tissue toward the suction line. In some examples, a cap or reflector can contain the tissue and deflect back-migrating tissue and tissue debris toward the suction line. In a further example, irrigation fluid can be directed at the tissue to guide the tissue toward the suction line.

[0009] The above description is intended to provide an overview of the subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive description of the invention. The following description is included to provide further information about the present application.

[0010] FIG. 1 shows a perspective and partial cross-sectional view of a lithotriptor 100. The lithotriptor 100 may include a lithotriptor 102 and a reflector 104. The lithotriptor 102 may include a body 106, a probe 108, and an aspiration lumen 110 (of the probe 108). The reflector 104 may include a body 112, a reflective surface 114, an opening 116, and a cavity 118. Also shown in FIG. 1 are tissue 50, tissue debris 52, and proximal and distal directional indicators. The tissue 50 may include any mass within a body lumen, such as soft tissue, hard tissue, or calcified tissue. A stone (such as a kidney stone or gallstone) may be a type of hardened tissue and / or may include sessile minerals or tissue, blood, or the like. The tissue 50 may also be free-floating (not attached to other tissues within the body lumen) within the body lumen. Alternatively, tissue 50 may be largely free-floating (eg, over an area representing more than 50% of the surface area), while the remainder is attached to other parts of the body.

[0011] The lithotriptor 102 may be a lithotriptor configured to engage or interact with tissue fragments in a patient's body lumen, such as a laser lithotriptor, ultrasonic lithotriptor, electromagnetic lithotriptor, or other lithotriptor. Lithotripsy may include tissue ablation, and the lithotriptor 102 may be configured to ablate the tissue. In the example shown in FIG. 1 , the lithotriptor 102 may be an ultrasonic electromagnetic lithotriptor configured for percutaneous use that delivers energy to the tissue 50, breaking the tissue 50 into fragments, such as shards 52, which are removed through the aspiration lumen 110 of the probe 108.

[0012] The lithotriptor body 106 may be an elongated member positionable outside the patient's body lumen near a tissue target including the tissue 50. The body 106 may support the probe 108 and may include one or more components configured to deliver energy to the probe 108, such as a piezoelectric stack and a waveguide. The body 106 may further include controls for operation of the lithotriptor 100. In some examples, the body 106 may be connected to a controller to receive power and / or control signals.

[0013] The lithotriptor's probe 108 may be an elongated member positionable within a patient's body lumen near a tissue target, including tissue 50. The body lumen may be any tissue or stone-forming area of ​​the body, such as within a kidney, the urinary tract (generally a patient's renal system), the biliary tract, etc. The probe 108 may be configured to deliver energy to tissue within a portion of the body lumen. The probe 108 may include an aspiration lumen 110 (or suction device), which may extend through the probe 108 and may be connected to a suction source at the body 106 or further upstream of the body 106. The aspiration lumen 110 may be sized to receive tissue debris, such as debris 52, for removal from the body lumen through the aspiration lumen 110.

[0014] The reflector 104 may be a cap configured to reflect tissue toward the probe 108. The reflector 104 may be a rigid or semi-rigid member that may be removably or rigidly connected to the probe 108 at the body 112. In some examples, the reflector 104 may be movably secured to the probe 108 such that the reflector 104 may expand along the longitudinal axis of the probe 108 or rotate relative to the probe 108, which may be useful for capturing tissue portions of various sizes within the cavity 118 of the reflector 104.

[0015] The body 112 can define a reflective surface 114, which can be a curved, arcuate, or otherwise shaped surface configured to reflect tissue 50 and its debris toward the probe 108 (and thus toward the aspiration lumen 110). The body 112 can also define an opening 116 therein, which can be connected to a cavity 118 and can be located proximal to the distal end of the probe 108. The cavity 118 can be sized to accommodate a portion of the lithotriptor 102 therein and can receive tissue 50 therein.

[0016] In some example operations, the lithotriptor 102 can be inserted near a tissue target within a patient's body lumen, such as near tissue 50 within the patient's body lumen. Using the body 106, the tissue 50 can be positioned adjacent to the distal portion (or tip) of the probe 108 through the opening 116 and into the cavity 118 of the reflector body 112. The probe 108 can then be actuated to deliver energy to the tissue 50, breaking the tissue into fragments. The fragments, such as fragment 52, can be removed through the aspiration lumen 110, thereby removing them from the patient's body lumen.

[0017] During interaction between the probe 108 and the tissue 50, energy applied to the tissue can cause rearward movement of the tissue, or distal movement relative to the probe 108 and reflector 104. Because the reflector 104 is positioned distally of the probe 108, debris or tissue 50 can engage the reflective surface 114 and be redirected proximally to further engage the probe 108 until the tissue 50 is completely (or nearly) removed through the aspiration lumen 110. By doing so, the reflector 104 can reverse the rearward movement and help to more quickly break up and remove the tissue 50 during the lithotripsy procedure.

[0018] Figure 2 shows a perspective view and partial cross-section of a portion of a lithotriptor 200. The lithotriptor 200 can include a lithotriptor 202 and a reflector 204. The lithotriptor 202 can include a body 206, a laser emitter 207, and an aspiration cannula 209 (including a lumen 210). The reflector 204 can include a body 212, a reflective surface 214, an opening 216, and a cavity 218. Also shown in Figure 2 are the tissue 50, beam B, reflected beam R, and proximal and distal directional indicators.

[0019] The lithotriptor 202 may be similar to the lithotriptor 102 described above, except that the lithotriptor 202 may use a laser emitter 207 as a modality for delivering energy to the tissue 50 to treat (or destroy) the tissue 50. The body 206 may be a rigid member in some instances and may be a flexible member, such as the flexible shaft of an endoscope (such as a cholangioscope or ureteroscope), in other instances. The body 206 may be configured to support the laser emitter 207, the suction cannula 209, and the reflector 204.

[0020] Laser emitter 207 may be a portion of a laser, such as an optical fiber, configured to deliver laser beam B to tissue 50 and break tissue 50 into small pieces for removal. Aspiration cannula 209 may be a flexible or semi-rigid suction device, such as a tube, positionable within body 206, such as the tube of an endoscope. Aspiration lumen 210 may extend through cannula 209, which may be connected to a suction source at the endoscope or further upstream of the endoscope. Aspiration lumen 210 may be sized to receive tissue debris, such as debris 52, for removal from a body lumen through aspiration lumen 210.

[0021] The reflector 204 may be a cap configured to deflect tissue particles toward the suction cannula 209. The reflector 204 may be a flexible or semi-rigid member that may be removably or rigidly connected to the body 206. In some examples, the reflector 204 may be movably secured to the body 206 such that the reflector 204 may expand along a longitudinal axis of the body 206 or rotate relative to the body 206, which may aid in capturing tissue of various sizes within a cavity 218 of the reflector 204. The body 212 may define an opening 216 therein, which may be connected to the cavity 218. The cavity 218 may be sized to accommodate a portion of the lithotriptor 202 therein and may receive tissue 50 therein.

[0022] The reflective surface 214 may be a curved, arcuate, or otherwise shaped surface configured to reflect tissue 50 and its debris toward the laser emitter 207 (and thus toward the aspiration lumen 210). The reflective surface 214 may also be curved (or otherwise shaped) to help direct the beam B toward the distal side of the tissue. In some examples, the reflective surface (and / or other portions of the body 212) may include a lining having a reflective coating composed of one or more of barium sulfate, magnesium oxide, polytetrafluoroethylene (PTFE, such as Spectralon), a dielectric highly reflective coating, a dichroic mirror, or a reflective photonic structure. Such a lining or coating may help increase the efficiency of the energy transferred to the tissue 50 by the reflected beam R.

[0023] In some example operations, the body 206 and the reflector 204 can be inserted into a tissue-forming region within a patient's body lumen, such as near the tissue 50 within the body lumen. In some examples, the endoscope 206 can be used to insert the laser emitter 207 and the reflector 204 into the body lumen. The body 206 can be used to position the tissue 50 through the opening 216 within the cavity 218 of the reflector body 212 so that the tissue 50 is near the suction cannula 209. The laser emitter 207 can then be activated to deliver beam B, which can reflect off the reflector's reflective surface 214 to generate reflected beam R, which can be directed by the reflective surface 214 toward a dorsal or distal portion of the tissue 50. The reflected beam can deliver energy to the tissue 50, causing it to fracture and create fragments (such as fragments 52) small enough to be removed from the patient through the suction lumen 210.

[0024] Because the reflected beam R is delivered from a distal direction, the tissue 50 can be urged or advanced toward the aspiration cannula 209 and the light emitter 207 rather than distally away from the light emitter 207 and the cannula 209, helping to limit (or reverse) rearward movement of the tissue 50. Additionally, if rearward movement of the tissue 50 does occur, the rearward movement can be limited by contact between the tissue 50 and the body 212 of the reflector 204.

[0025] In some examples, the reflective surface 214 can be configured (e.g., shaped and sized) to direct the beam B toward the center of the cavity 218. In another example, the reflective surface 214 can be configured to direct the beam B toward another portion(s) of the cavity 218, such as above the aspiration cannula 209. In some embodiments, the beam B can be delivered to the tissue 50 from a proximal direction.

[0026] Figure 3A shows a perspective view of the lithotriptor 300 in an open position. Figure 3B shows a perspective view of the lithotriptor 300 in a closed position. Figures 3A and 3B are discussed together below.

[0027] Lithotriptor 300 may include a lithotriptor 302 and a reflector 304. Lithotriptor 302 may include a body 306, a laser emitter 307, and an aspiration cannula 309 (including a lumen 310). Reflector 304 may include a body 312, a reflective surface 314, an opening 316, a cavity 318, and a neck 320. Also shown in Figures 3A and 3B are tissue 50, beam B, reflected beam R, and proximal and distal directional indicators.

[0028] The lithotriptor 302 may be similar to the lithotriptor 202 of FIG. 2, except that the laser emitter 307 may extend distally beyond the suction cannula 309. The reflector 304 may be a reflector configured to reflect the beam B emitted by the emitter 307. The reflector 304 may differ in shape from the reflector 202 and may differ in that the reflector 304 may be configured to capture and hold tissue 50. Any of the lithotriptors described above or below may be modified to include such a reflector.

[0029] The neck 320 may be a portion of the reflector 304 having a relatively small diameter for connecting the body 312 to the lithotriptor 302 (such as the body 306 of the lithotriptor 302). The body 312 may extend laterally from the neck 320, as the body 312 extends distally from the neck 320 to form a bulb shape. In some examples, the body 312 may have other shapes, such as a spherical or approximately spherical shape. The body 312 may be operable to open and close the opening 316 to capture tissue within the cavity 318. In some examples, the body 312 may be made in multiple sections to allow the body 312 to move between the open position of FIG. 3A and the closed position of FIG. 3B. The reflective surface 314 of the body 312 may be polished and / or include a coating to increase the reflectivity of the reflective surface 314.

[0030] In some example operations, the body 306 can be used to place the tissue 50 through the opening 316 and into the cavity 318 of the reflector body 312. Once the tissue 50 is in the cavity 318, the body 306 (or another control) can be operated to close the opening 316 in the body 312, trapping the tissue 50 within the cavity 318 of the reflector 304. The laser emitter 307 can then be activated to deliver a beam B, which can be delivered to the tissue 50. Backward movement of the tissue 50 can be prevented by contact between the tissue 50 and the reflector 204.

[0031] Additionally, beam B can reflect off the reflective surface 314 of reflector 304 to generate reflected beam R, which can be directed by the reflective surface 314 toward a dorsal or distal portion of tissue 50. Reflected beam R delivers energy to tissue 50, fragmenting it and creating fragments small enough to be removed from the patient through aspiration lumen 310. Delivery of reflected beam R distal to tissue 50 can also cause a reversal of the rearward movement, helping to direct tissue 50 toward aspiration cannula 309. In some instances, such as when tissue 50 is too large for cavity 318 and prevents opening 316 from closing, the laser can be activated when body 312 is in the open position. Individual or multiple fragments can then be captured by the reflector to complete the lithotripsy procedure and remove tissue 50.

[0032] 4A shows a perspective view of a portion of a lithotriptor 400A according to at least one example of the present disclosure. The lithotriptor 400A can include an endoscope or body 406, an aspiration cannula 410, a body 412, an opening 416, a cavity 418, an irrigation source 422, actuators 424a and 424b, and crushing features 426 and 428. Also shown in FIG. 4A are directional indicators, with proximal and distal arrows D.

[0033] Endoscope or body 406 may be a portion of an endoscope (e.g., a ureteroscope, a cholangioscope, etc.) configured for insertion into a portion of a body lumen to support and guide suction cannula 410 and irrigation source 422. In some examples, body 406 may be an integral part of a lithotriptor configured to support suction cannula 410 and irrigation source 422. Irrigation source 422 may be a tube configured to carry and expel fluid into cavity 418 to flush tissue debris from cavity 418 through cannula 410.

[0034] Body 412 may be a rigid or semi-rigid member optionally connected to body 406. Body 412 may have an opening 416 formed therein, which may be connected to a cavity 418, which may be sized and shaped to support tissue therein. Actuators 424a and 424b are connected to body 412 and may be configured to move body 412 in direction D (proximal and distal directions). In some examples, actuators 424a and 424b may be piezoelectric stacks or other drivers configured to vibrate (translate) body 412 relative to body 406.

[0035] Breaking features 426 and 428 can be connected to a proximal face of the distal portion of the body and can be directed proximally toward aspiration cannula 410. Each of breaker features 426 and 428 can be configured to engage tissue pieces to crush or pulverize the tissue. In some examples, breaker features 426 and 428 are differently shaped and / or oriented in different directions, allowing them to engage tissue of different shapes and sizes and from different directions, helping to effectively pulverize tissue of different shapes and sizes.

[0036] 4B shows a perspective view of a portion of a lithotriptor 400 B. The lithotriptor 400 B may be similar to the lithotriptor 400 A described above, except that the lithotriptor 400 B may include a probe 408 .

[0037] Probe 408 can be connected to a distal outer portion of body 412. Probe 408 can be similar to probe 108 in that probe 400 can be connected to one or more components configured to deliver energy to probe 408, such as a piezoelectric stack and a waveguide. Probe 408 can be positionable near a tissue formation target including tissue within a body lumen of a patient (e.g., within the renal system) and can be configured to deliver energy to tissue within a portion of the body lumen.

[0038] For example, probe 408 can be used to crush or pulverize tissue that is too large to place into cavity 418 through opening 416. Once the tissue is small enough, it can be placed into cavity 418, crushing features 426 and 428 can be used to break the tissue in a more controlled environment, and a back movement reversal can be used to guide the tissue and tissue fragments toward aspiration cannula 410 to remove the tissue from the body lumen.

[0039] 4C shows a perspective view of a portion of a lithotriptor 400C, according to at least one example of the present disclosure. The lithotriptor 400C can be similar to the lithotriptor 400A described above, except that the lithotriptor 400C can include externally mounted crushing features 426 and 428.

[0040] For example, crushing features 426 and 428 can be used to crush or pulverize tissue that is too large to place into cavity 418 through opening 416, and the tissue fragments can be removed through suction cannula 410. Once the tissue is small enough, it can be placed into cavity 418, other methods (such as lasers, internal crushing features, and / or internal probes) can be used to disrupt the tissue in a more controlled environment, and a back movement reversal can be used to guide the tissue and tissue fragments toward suction cannula 410 to remove the tissue from the body lumen.

[0041] Figure 5A shows a cross-sectional view of a portion of the lithotriptor 500 in the open position along index line 5A-5A in Figure 5B. Figure 5B shows a cross-sectional view of a portion of the lithotriptor 500 in the open position along index line 5B-5B in Figure 5A. Figure 5C shows a cross-sectional view of a portion of the lithotriptor 500 in the closed position along index line 5C-5C in Figure 5D. Figure 5D shows a cross-sectional view of a portion of the lithotriptor 500 in the closed position along index line 5D-5D in Figure 5C. Figure 5E shows a cross-sectional view of a portion of the lithotriptor 500 in the closed position while expelling irrigation fluid. Figures 5A-5E are discussed together below.

[0042] The lithotriptor 500 may include an inner sleeve 502 and an outer sleeve 504. The inner sleeve 502 may have an opening 506 defined therein. The outer sleeve 504 may have an opening 508 defined therein. The lithotriptor 500 may also include an irrigation system 510 including a header 512 and a nozzle 514. Also shown in Figures 5A-5E are tissue 50, axis A, fluid f, directional arrows D and R, and proximal and distal directional indicators.

[0043] The lithotriptor 500 may be similar to the lithotriptors described above and may include a lithotriptor probe for delivering ultrasonic energy to tissue and / or a laser emitter for emitting a laser beam toward tissue. In some examples, the lithotriptor 500 may be connected to any type of lithotriptor, and in some examples, the lithotriptor 500 may be connected to an endoscope.

[0044] The inner sleeve 502 can be a semi-rigid or flexible member extending along a longitudinal axis A. The inner sleeve 502 can be connected to the outer sleeve 504 and configured to rotate relative to the outer sleeve 504. The inner sleeve 502 can define an opening 506 therein, which can extend through the inner sleeve 502 near a distal end of the inner sleeve 502. Similarly, the outer sleeve 504 can be a semi-rigid or flexible member extending along a longitudinal axis A. The outer sleeve 504 can be connected to the inner sleeve 502 and configured to rotate relative to the inner sleeve 502. In some examples, the inner sleeve 502 and the outer sleeve 504 can be configured to flex together, such as within a patient's cavity during a procedure.

[0045] The outer sleeve 504 can define an opening 508 therein, which can extend through the outer sleeve 504 near a distal end thereof. The inner sleeve 502 can be connected to a suction device for removing debris (such as tissue debris) and fluid (such as fluid f) from the inner sleeve 502 and the outer sleeve 504. In some examples, a header 512 of the irrigation system 510 can connect the inner sleeve 502 to the outer sleeve 504 to allow rotation of the outer sleeve 504 relative to the inner sleeve 502.

[0046] Irrigation system 510 may be an irrigation system connected to a fluid source to deliver irrigation fluid to inner sleeve 502 and outer sleeve 504. In some examples, nozzles 514 may be connected to (or formed within) header 512 and configured to eject irrigation fluid or solution into the cavity and into inner sleeve 502 (and outer sleeve 504).

[0047] In some example operations, the lithotriptor 500 can be inserted into a body lumen so that it is near or at a tissue target. Before or after insertion into the cavity, the outer sleeve 504 can be rotated relative to the inner sleeve 502 so that the opening 506 is aligned with the opening 508, as shown in FIGS. 5A and 5B. With the openings 506 and 508 in the open position, the device 500 can be used to pass tissue 50 through the openings 506 and 508 into the cavity 518 of the inner sleeve 502. Once the tissue is in the cavity 518, the outer sleeve 504 (or the inner sleeve 502) can be rotated in a direction R about the axis A, as shown in FIG. 5D, so that the openings 506 and 508 are no longer aligned, as shown in FIGS. 5C and 5D. In some examples, the outer sleeve 504 (or the inner sleeve 502) can be rotated in either direction about the axis A to open or close the openings 506 and 508.

[0048] Once the tissue 50 is captured by the outer sleeve 504, lithotripsy can be performed on the tissue 50, and the inner sleeve 502 and outer sleeve 504 can contain the tissue 50 and its fragments therein, which can help limit rearward migration of the tissue during lithotripsy. Also, once the tissue 50 is captured by the outer sleeve 504, the irrigation system can be enabled such that the nozzle 514 ejects fluid f in direction D, which helps direct the tissue 50 and tissue debris toward a suction device (such as any of the suction devices described above that can be incorporated into the lithotripsy device 500), further helping to reverse the rearward migration of the tissue 50 and its fragments during lithotripsy and promoting relatively rapid removal of the fragments. Lithotripsy can be performed on the tissue 50 until the tissue fragments are pulled out of the cavity 518 through the suction device. The lithotripsy device 500 can then be removed from the cavity 518.

[0049] Figure 6 shows a cross-sectional view of a portion of a lithotriptor 600. The lithotriptor 600 may include a lithotriptor 602, a reflector 604, and an endoscope 606. The lithotriptor 602 may include laser emitters 607a and 607b (collectively referred to as laser emitters 607). The lithotriptor 600 may also include an aspiration cannula 609 (including a lumen 610). The reflector 604 may include a body 612, a reflective surface 614, an opening 616, and a cavity 618. Also shown in Figure 6 are tissue 50, beams Ba and Bb, reflected beams Ra and Rb, and proximal and distal directional indicators.

[0050] The lithotriptor 600 may be similar to the lithotriptor 200 described above, except that the lithotriptor 600 may include an endoscope (e.g., a ureteroscope or cholangioscope) 606, which may support a laser emitter 607 and a suction cannula 609. Additionally, the reflector 604 may be attached (e.g., removably attached) to the endoscope 606. The lithotriptor 600 may also differ in that it includes two laser emitters 607a and 607b positioned on either side of the cannula 609. While two laser emitters 607a and 607b are shown, the lithotriptor may include more laser emitters, such as three, four, five, six, seven, eight, nine, ten, etc.

[0051] In some examples, the reflective surface 614 can be shaped so that beams Ba and Bb emitted by light emitters 607a and 607b, respectively, are reflected toward a central portion of cavity 618 (shown as reflected beams Ra and Rb, respectively) to direct the beams toward tissue 50. The use of reflected beams Ra and Rb for lithotripsy can help reverse back migration and can help reduce the time required to fragment tissue 50 and remove it through aspiration lumen 610. Any of the lithotripsy devices described above and / or below can be modified to include multiple laser emitters.

[0052] Figure 7 shows a perspective view and partial cross-sectional view of a portion of a lithotriptor 700. The lithotriptor 700 may include a lithotriptor 702 and a reflector 704. The lithotriptor 702 may include a body 706 and a probe 708 (including a lumen 710). The reflector 704 may include a body 712 defining a reflective surface 714 and an opening 716. The reflector 704 may also include an irrigation system 740, which may include a nozzle 742. Also shown in Figure 7 is a fluid f and proximal and distal directional indicators.

[0053] The lithotriptor 700 may be similar to the lithotriptor 100 of Figure 1, except that the lithotriptor 700 may include an irrigation system 740, which may include a channel 744 routed through the body 712 of the reflector 704, where the channel 744 is configured to support the flow of a fluid therethrough. The channel 744 may be connected to a nozzle 742, which may be configured to eject a fluid f at or near the reflective surface 714.

[0054] In operation, the reflector 704 can be positioned in or near a body lumen, for example, adjacent to tissue 50. The reflector 704 can be positioned to pass tissue 50 through the opening 716 in the body 712, allowing the tissue to enter the cavity 718 of the reflector 704. The lithotriptor 702 can then be used to fragment the tissue 50, such as by engaging the tissue 50 with the probe 708 to transfer energy to the tissue 50.

[0055] During lithotripsy, the irrigation system 740 can be activated, and fluid f can be supplied to the nozzle 742 through the channel 744 and ejected toward the aspiration lumen 710, which can serve to reverse the backward movement of the tissue 50 and guide pieces or fragments of tissue 50 toward the lumen 710 for removal from the reflector 704 and, therefore, from the patient's cavity. Also, if the probe 708 causes backward movement of the tissue 50 during lithotripsy, the irrigation system 740 can serve to advance or urge the tissue 50 proximally toward the probe 708, which can serve to reduce the time required for the fragmentation and removal of the tissue 50. Any of the lithotripsy devices described above and / or below can be modified to include such an irrigation system.

[0056] FIG. 8 shows a perspective view and partial cross-sectional view of a portion of a lithotriptor 800. The lithotriptor 800 may include a lithotriptor 802, a reflector 804, and an endoscope 806. The lithotriptor 802 may include a laser emitter 807. The lithotriptor 800 may also include a suction cannula 809 (including a lumen 810). The reflector 804 may include a body 812, a reflective surface 804, an opening 816, and a cavity 818. The reflector 804 may also include an irrigation system 840, which may include a nozzle 842 and a channel 844. Also shown in FIG. 8 are a fluid f and proximal and distal directional indicators.

[0057] 2 except that the lithotriptor 800 can include an irrigation system 840, which can include a channel 844 routed through the reflector 804, which can be configured to support fluid flow therethrough. The channel 844 can be connected to a nozzle 842 such that the nozzle 842 can eject a fluid f at or near the reflecting surface 814.

[0058] In operation, the reflector 804 can be positioned at or near the tissue formation area, for example, adjacent to the tissue 50, and can be positioned to allow the tissue 50 to pass through the opening 816 in the body 812 and enter the cavity 818 of the reflector 804. The tissue 50 can then be fragmented using the lithotriptor 802, such as by emitting a beam from the light emitter 807 onto the tissue 50 (which can be reflected by the reflective surface 814).

[0059] During lithotripsy, the irrigation system 840 can be activated and fluid f can be supplied to the nozzle 842 through the channel 844 and expelled towards the aspiration lumen 810, which can serve to reverse the backward movement of the tissue 50 and guide pieces or fragments of tissue 50 towards the lumen 810 for removal from the reflector 804 and thus from the patient's cavity. Any of the lithotripsy devices described above or below can be modified to include such an irrigation system.

[0060] Figure 9A shows a cross-sectional view of a portion of the lithotriptor 900 taken along index line 9A-9A in Figure 9B. Figure 9B shows a cross-sectional view of a portion of the lithotriptor 900 taken along index line 9B-9B in Figure 9A. Figures 9A and 9B are discussed together below.

[0061] The lithotriptor 900 may include a lithotriptor 902 and a reflector 904. The lithotriptor 902 may be similar to any of the lithotriptors described above. The reflector 904 may include a body 912 that may define an opening 916 and a cavity 918. The reflector 904 may also include an irrigation system 940 that may include nozzles 942a-942n (collectively referred to as nozzles 942), channels 944a-944c (collectively referred to as channels 944), and a header 946. Also shown in Figures 9A and 9B are a fluid flow path f and proximal and distal directional indicators.

[0062] The channels 944 may be routed (e.g., individually) through the body 912 and may connect to a header 946, which may be connected to a nozzle 942. During a lithotripsy procedure, a fluid f may be supplied to the channels 944 and the header 946 and distributed to the nozzle 942. The nozzle 942 may be shaped, positioned, and / or configured to expel the fluid f proximally from the nozzle 942, propelling tissue proximally or toward the suction device of the lithotriptor 902. Any of the lithotriptors described above or below may be modified to include such an irrigation system.

[0063] Figure 10 shows a cross-sectional view of a portion of a lithotriptor 1000. The lithotriptor 1000 may include a lithotriptor 1002, a reflector 1004, an endoscope 1006, a distal camera 1050, a reflector camera 1052, and a scope camera 1054. The lithotriptor 1002 may include a laser emitter 1007. The lithotriptor 1000 may also include a suction cannula 1009 (including a lumen 1010). The reflector 1004 may include a body 1012, a reflective surface 1014, an opening 1016, and a cavity 1018. Also shown in Figure 10 are proximal and distal directional indicators.

[0064] The lithotriptor 1000 may be similar to each of the lithotriptors described above, except that the lithotriptor 1000 may include a distal camera 1050 , a reflector camera 1052 , and a scope camera 1054 .

[0065] Each of the distal camera 1050, the reflector camera 1052, and the scope camera 1054 may be a digital camera device (or imaging device) configured to generate an optical or image signal based on an image of the lithotriptor's surroundings. The distal camera 1050 may be connected to a distal portion of the reflector 1004 and may be positioned and configured to have a field of view in front of or distal to the reflector 1004. The reflector camera 1052 may be connected to an internal portion of the reflector 1004 and may be positioned and configured to have a field of view of the opening 1016. The scope camera 1054 may be connected to a distal portion of the scope (e.g., near the opening 1016) and may be positioned and configured to have a field of view of the opening 1016 and the reflective surface 1014.

[0066] In some example operations, a lithotriptor can be inserted into the cavity 1018. Using a distal camera 1050 on the reflector 1004, the reflector can be positioned near tissue within the tissue target, for example, near the opening 1016 in the body. The reflector camera 1052 and the scope camera 1054 can then be used, respectively, to guide the tissue through the opening 1016 and into the cavity 1018, and the cameras can be further used to position the tissue within the cavity before and during lithotripsy of the tissue.

[0067] Although the lithotriptor 1000 is shown as including three cameras, it may include fewer or more cameras, such as 1, 2, 4, 5, 6, 7, 8, 9, 10, etc.

[0068] 11 illustrates a block diagram of a lithotripsy system 1100 capable of performing or facilitating any one or more of the techniques described above. The computer system 1100 may be used specifically in connection with facilitating the operation of the lithotripsy devices 100-1000 described or referenced herein. For example, the computer system 1100 may be connected to a distal camera 1050, a reflector camera 1052, a scope camera 1054, and a light emitter 1007.

[0069] In alternative embodiments, system 1100 may operate as a stand-alone device or may be connected (e.g., networked) to other machines. In a networked deployment, a machine may operate as either a server or a client machine in a server-client network environment, or function as a peer machine in a peer-to-peer (or distributed) network environment. A machine may be a personal computer (PC), a tablet PC, a smartphone, a web appliance, or any machine capable of executing instructions (sequential or otherwise) that specify operations to be performed by the machine. Furthermore, while only one machine is shown, the term "machine" shall also be taken to include any collection of machines that individually or jointly execute a set (or sets) of instructions to perform any one or more of the methodologies discussed herein.

[0070] The computer system 1100 may include a processor 1102 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), or both), a main memory 1104, and a static memory 1106, which communicate with each other via a link 1108 (e.g., an interlink, a bus, etc.). The computer system 1100 may also include a video display unit 1110, an alphanumeric input device 1112 (e.g., a keyboard), and a user interface (UI) navigation device 1114 (e.g., a mouse). In one example, the video display unit 1110, the input device 1112, and the UI navigation device 1114 are touchscreen displays. The computer system 1100 may additionally include a storage device 1116 (e.g., a drive device), a signal generating device 1118 (e.g., a speaker), and a network interface device 1120 that can operatively communicate with a communication network 1126 using wired or wireless communication hardware. The computer system 1100 may further include one or more human input sensors 1128 configured to obtain input (including contactless human input) according to input recognition and detection techniques. The human input sensors 1128 may include a camera, microphone, barcode reader, RFID reader, near field communication reader, or other sensor that generates data for input purposes. The computer system 1100 may further include an output controller 1130, such as a serial (e.g., Universal Serial Bus (USB), parallel, or other wired or wireless (e.g., infrared (IR)) connection for communication or control to one or more peripheral devices (e.g., printer, card reader, etc.).

[0071] The storage device 1116 may include a machine-readable medium 1122 having stored thereon one or more sets of data structures or instructions 1124 (e.g., software) that embody or are used by any one or more of the methodologies or functions described herein. The instructions 1124 may also reside, completely or at least partially, within the main memory 1104, the static memory 1106, and / or within the processor 1102 during execution of the instructions 1124 by the computer system 1100, with the main memory 1104, the static memory 1106, and the processor 1102 also constituting machine-readable media.

[0072] While machine-readable medium 1122 is illustrated as a single medium in the exemplary embodiment, the term "machine-readable medium" can include one medium or multiple media (e.g., a centralized or distributed database and / or associated caches and servers) that store one or more instructions 1124. The term "machine-readable medium" should also be taken to include any tangible medium (e.g., non-transitory medium) that can store, encode, or carry instructions for execution by computer system 1100, cause computer system 1100 to perform any one or more of the methodologies of this disclosure, or store, encode, or carry data structures utilized by or associated with such instructions. Thus, the term "machine-readable medium" should be taken to include, but not be limited to, solid-state memory and optical and magnetic media. Specific examples of machine-readable media include non-volatile memory, which includes, by way of example, semiconductor memory devices (e.g., electrically programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM)) and flash memory devices, magnetic disks such as internal hard disks and removable disks, magneto-optical disks, and CD-ROM and DVD-ROM disks.

[0073] The instructions 1124 may further be transmitted or received over a communications network 1126 using a transmission medium via the network interface device 1120 utilizing any one of a number of well-known transport protocols (e.g., Frame Relay, Internet Protocol (IP), Transmission Control Protocol (TCP), User Datagram Protocol (UDP), Hypertext Transfer Protocol (HTTP)). Examples of communications networks include a local area network (LAN), a wide area network (WAN), the Internet, a cellular network, a plain old telephone service (POTS) network, and wireless data networks (Wi-Fi, 3G, and 4G LTE / LTE-A or 5G networks). The term “transmission medium” shall be interpreted to include any intangible medium capable of storing, encoding, or carrying instructions for execution by the computing system 1100, including digital or analog communications signals or other intangible media for facilitating communication of such software.

[0074] As an additional example, the computing embodiments described herein may be implemented by one or a combination of hardware, firmware, and software. Each embodiment may also be implemented as instructions stored on a computer-readable storage device, which may be read and executed by at least one processor to perform the operations described herein. A computer-readable storage device may include any non-transitory mechanism for storing information in a form readable by a machine (e.g., a computer). For example, a computer-readable storage device may include read-only memory (ROM), random access memory (RAM), magnetic disk storage media, optical storage media, flash memory devices, and other storage devices and media.

[0075] It should be understood that functional units or capabilities described herein may be referred to or labeled as components or modules to more specifically emphasize their implementation independence. A component or module may be implemented by any combination of hardware circuits, programmable hardware devices, or other discrete components. A component or module may also be implemented by software for execution on various types of processors. An identified component or module of executable code may be, for example, one or more physical or logical blocks of computer instructions, which may be organized as an object, procedure, or function. However, the executable files of an identified component or module need not be physically located together and may include different instructions stored in separate locations that, when logically combined, constitute the component or module and achieve the specified purpose of the component or module. In fact, a component or module of executable code may be a single instruction or multiple instructions and may even be distributed across several different code segments, among different programs, and even across several memory devices.

[0076] Similarly, operational data may be identified and described herein within components or modules and may be embodied in any suitable form and organized within any suitable type of data structure. Operational data may be collected as a single data set or may be distributed across a variety of different locations, including a variety of different storage devices, and may exist at least in part only as electronic signals on a system or network. Components or modules may be passive or active and include agents operable to perform desired functions.

[0077] Notes and Examples The following non-limiting examples detail particular aspects of the present subject matter that, among other things, solve the problems and provide the advantages discussed herein.

[0078] Example 1 is a retrograde translation reversal device comprising a lithotriptor configured to deliver energy to tissue located in a tissue formation region, a retrieval channel positionable in or near a body lumen, and an energy director positionable near the lithotriptor and the retrieval channel, the energy director configured to advance tissue toward the retrieval channel.

[0079] In Example 2, the subject matter of Example 1 optionally includes the lithotriptor comprising a laser emitter operable to deliver light energy to the tissue.

[0080] In Example 3, the subject matter of Example 2 optionally includes the energy directing device comprising a reflector, the reflector being connected to the lithotriptor and positionable to reflect light energy to advance tissue toward the retrieval channel.

[0081] In Example 4, the subject matter of Example 3 optionally includes the lithotriptor comprising a second laser emitter operable to deliver light energy to the reflector.

[0082] In Example 5, the subject matter of any one or more of Examples 2-4 optionally includes, wherein the reflector comprises a reflective coating comprised of one or more of barium sulfate, magnesium oxide, a dielectric highly reflective coating, polytetrafluoroethylene, a dichroic mirror, and a reflective photonic structure.

[0083] In Example 6, the subject matter of any one or more of Examples 1-5 optionally includes, wherein the lithotriptor is an ultrasonic lithotriptor.

[0084] In Example 7, the subject matter of any one or more of Examples 1-6 optionally includes: the energy directing device comprising a reflector connected to the lithotriptor, the reflector configured to reflect a portion of the tissue toward the retrieval channel.

[0085] In Example 8, the subject matter of any one or more of Examples 1-7 optionally includes: the energy directing device comprising a reflector connected to the endoscope, the reflector configured to reflect a portion of the tissue toward the recovery channel.

[0086] In Example 9, the subject matter of any one or more of Examples 1-8 optionally includes a capture device connected to the lithotriptor and positionable in or near the body lumen, the capture device operable to move between an open position for capturing tissue and a closed position for retaining the tissue therein.

[0087] In Example 10, the subject matter of Example 9 optionally includes, wherein the energy directing device includes a capture device.

[0088] In Example 11, the subject matter of Example 10, optionally including the capturing device including a reflective inner surface for reflecting light delivered by the lithotriptor laser onto tissue within the capturing device.

[0089] In Example 12, the subject matter of any one or more of Examples 9-11 optionally includes the capture device comprising an inner sleeve defining an opening for receiving tissue within the inner sleeve adjacent the retrieval passage and the lithotriptor, and an outer sleeve connected to the inner sleeve, the outer sleeve movable to open and close the opening.

[0090] In Example 13, the subject matter of Example 12 optionally includes the outer sleeve being rotatable relative to the inner sleeve about an axis common to the outer sleeve and inner sleeve so as to open and close the opening in the inner sleeve.

[0091] In Example 14, the subject matter of any one or more of Examples 1-13, optionally including the energy directing device including an outer sleeve translatable relative to the lithotriptor to apply a force to the tissue to advance the tissue toward the retrieval channel.

[0092] In Example 15, the subject matter of Example 14 optionally includes the energy directing device including a plurality of protrusions extending proximally from a distal portion of the outer sleeve, the protrusions configured to apply force to tissue to disrupt the tissue.

[0093] In Example 16, the subject matter of any one or more of Examples 1-15, optionally including, the energy director configured to eject irrigation fluid toward the collection passage.

[0094] In Example 17, the subject matter of Example 16 optionally includes the energy directing device including a perfusion device connected to a distal portion of the energy directing device, the perfusion device configured to eject fluid toward the collection passage.

[0095] In Example 18, the subject matter of Example 17, optionally including the perfusion device including a plurality of jets for ejecting fluid to propel tissue toward the collection channel.

[0096] In Example 19, the subject matter of any one or more of Examples 1-18 optionally includes an imaging device coupled to an exterior portion of the energy director device.

[0097] In Example 20, the subject matter of any one or more of Examples 1-19, optionally including: the body lumen is a renal target; and the tissue is a stone.

[0098] Example 21 is a rearward translation reversal device for performing lithotripsy, comprising: a lithotriptor configured to deliver energy to tissue in a body lumen; a recovery channel positionable near the energy delivery device at or near the body lumen; and a reflector positionable distal to the lithotriptor at or near the body lumen, the reflector configured to direct energy from the lithotriptor toward the tissue to propel the tissue toward the recovery channel.

[0099] In Example 22, the subject matter of Example 21 optionally includes the lithotriptor comprising a laser emitter operable to deliver light energy to the tissue.

[0100] In Example 23, the subject matter of Example 22 optionally includes a reflector connected to the lithotriptor.

[0101] In Example 24, the subject matter of Example 23 optionally includes the lithotriptor comprising a second laser emitter operable to deliver light energy to the reflector.

[0102] In Example 25, the subject matter of Example 24 optionally includes the reflector including a curved reflective surface that focuses the reflected light toward the collection path.

[0103] In Example 26, the subject matter of any one or more of Examples 22-25, optionally including the reflector comprising a reflective coating comprised of one or more of barium sulfate, magnesium oxide, a dielectric highly reflective coating, a dichroic mirror, and a reflective photonic structure.

[0104] Example 27 is a rearward translation reversal device for performing lithotripsy, comprising: a lithotriptor configured to deliver energy to tissue within a cavity in a body lumen; a recovery channel positionable near the energy delivery device at or near the body lumen; and a perfusion device positionable distal to the lithotriptor at or near the body lumen, the perfusion device configured to direct fluid to urge tissue toward the recovery channel.

[0105] In Example 28, the apparatus or method according to any one or any combination of Examples 1 to 27 can be optionally configured to use or select all of the described elements or options.

[0106] The above detailed description includes references to the accompanying drawings, which form a part of this description. The drawings show, by way of illustration, specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as "examples." Such examples may include elements in addition to those shown and described herein. However, the inventors also contemplate examples in which only the elements shown or described are provided. Moreover, the inventors also contemplate examples using any combination or permutation of the elements shown or described (or one or more aspects thereof) with respect to a particular example (or one or more aspects thereof) or with respect to other examples (or one or more aspects thereof) shown or described herein.

[0107] In the event of a conflict in usage between this specification and a document incorporated by reference, the usage in this specification shall control. As used herein, the terms "including" and "in which" are used as the plain English equivalents of the terms "comprising" and "wherein," respectively. Also, in the following claims, the terms "including" and "comprising" are open-ended, i.e., systems, devices, articles, components, compositions, or processes that include elements in addition to the elements recited after such terms in a claim are also considered to be within the scope of that claim.

[0108] The foregoing description is intended to be illustrative, not limiting. For example, the above examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments may be utilized by one of ordinary skill in the art, such as by studying the above description. The Abstract is provided to comply with 37 CFR 1.72(b) to enable the reader to quickly grasp the nature of the technical disclosure. The Abstract is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Additionally, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be construed as intending that any disclosed feature not recited in a claim is essential to that claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full range of equivalents to which such claims are entitled.

Claims

1. a lithotriptor including an elongated body and an energy delivery device configured to deliver energy to tissue located in the tissue formation region; a suction passageway connected to the elongate body and positionable in or near a body lumen; an energy director connected to the elongate body and positionable near the energy delivery device and the suction passage, the energy director configured to advance the tissue toward the suction passage; the energy director includes a reflector connected to the elongate body, the reflector configured to engage the portion of tissue to reflect the portion of tissue toward the suction passage; and and a capture device connected to the elongate body and positionable in or near the body lumen, the capture device operable to move between an open position to capture the tissue and a closed position to hold the tissue therein. Rearward movement reversing device.

2. The back translation reversal device of claim 1 , wherein the energy delivery device comprises a laser emitter operable to deliver light energy to the tissue.

3. The back translation reversal device of claim 2 , wherein the reflector is configured to reflect light energy to advance the tissue toward the aspiration passageway.

4. The back motion reversal device of claim 3 , wherein the energy delivery device comprises a second laser emitter operable to deliver light energy to the reflector.

5. 3. The back translation reversal device of claim 2, wherein the reflector comprises a reflective coating comprised of one or more of barium sulfate, magnesium oxide, a dielectric highly reflective coating, polytetrafluoroethylene, a dichroic mirror, and a reflective photonic structure.

6. The retrograde translation reversal device of claim 1 , wherein the energy delivery device comprises an ultrasonic lithotriptor.

7. The back motion reversal device of claim 1 , wherein the energy director comprises the capture device.

8. 8. The back translation reversal device of claim 7, wherein said capture device includes a reflective inner surface for reflecting light delivered by a laser of said lithotriptor back to said tissue within said capture device.

9. The capture device is an inner sleeve defining an opening for receiving the tissue within the inner sleeve adjacent the aspiration passage and the lithotriptor; 2. The back translation reversal device of claim 1, comprising an outer sleeve connected to the inner sleeve, the outer sleeve being movable to open and close the opening.

10. 10. The rearward translation reversing device of claim 9, wherein the outer sleeve is rotatable relative to the inner sleeve about an axis common to the outer and inner sleeves to open and close the opening in the inner sleeve.

11. The back translation reversal device of claim 1 , wherein the energy director comprises a sleeve translatable relative to the lithotriptor to apply a force to the tissue to urge the tissue toward the aspiration channel.

12. 12. The retrograde translation reversal device of claim 11, wherein the energy director includes a plurality of protrusions extending proximally from a distal portion of the sleeve, the plurality of protrusions configured to apply a force to the tissue to disrupt the tissue.

13. The rearward translation reversal device of claim 1 , wherein the energy director is configured to eject irrigation fluid toward the aspiration passageway.

14. 14. The rearward translation reversal device of claim 13, wherein the energy director includes an irrigation device connected to a distal portion of the energy director, the irrigation device configured to eject fluid toward the aspiration passage.

15. 15. The back translation reversal device of claim 14, wherein the irrigation device includes a plurality of jets for ejecting fluid to urge the tissue toward the aspiration passage.

16. 1. A retrograde reversal device for performing lithotripsy, comprising: a lithotriptor including an energy delivery device configured to transfer energy to tissue in a body lumen; a suction passageway positionable near the energy delivery device at or near the body lumen; a reflector secured to the lithotriptor at or near the body lumen, the reflector configured to engage the tissue portion to deflect the tissue portion toward the aspiration passage; an inner sleeve defining an opening for receiving the tissue within the inner sleeve adjacent the aspiration passage and the lithotriptor; an outer sleeve connected to the inner sleeve, the outer sleeve being movable to open and close the opening; A rearward movement reversing device comprising:

17. 17. The back translation reversal device of claim 16, wherein the lithotriptor comprises a laser emitter operable to deliver light energy to the tissue.

18. The back translation reversal device of claim 1 , wherein the reflector includes a curved or arcuate surface configured to deflect the tissue toward the suction passage.

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